Having enough suitable living space is a key determinant of health outcomes around the world, a review of studies on housing improvements for health has found.

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Initiatives targeting housing improvements at the most impoverished people and those in the poorest health were more effective than generic schemes targeting entire areas, the review found.

"If you want tangible health improvements, it is better to focus on targeting individuals with existing health problems," says Hilary Thomson, lead author of the paper and senior investigator scientist at the Medical Research Council's Social and Public Health Sciences Unit in Glasgow, United Kingdom.

The review, published online last week (28 February) in the Cochrane Library, analysed 39 studies to investigate whether investment in improving the physical fabric of housing is linked with better health. Three of the studies were in developing countries: Bangladesh, Cuba and Paraguay.

The Paraguayan study examined the reduction in Chagas disease caused by efforts to reduce exposure to its insect vector, such as removing cracks in walls and ceilings, and improving ventilation and light.

The Bangladeshi study looked at the impact on diarrhea levels in households that received water hand pumps and sealed double-pit water latrines.

Other studies included health outcomes as diverse as flu symptoms and mental health. Few adverse impacts of these housing improvements on health were reported.

Overall, good predictors of better health were found to be a sufficient amount of self-reported space for household needs and a comfortable living temperature.

But Thomson says health improvements are only possible if people can afford adequate, suitable and region-specific housing.

"Money is a big determinant of health," she says. "Housing costs affect disposable incomes and impact on the ability to have enough food. "Peter Williams, founder and executive director of charity Architecture for Health in Vulnerable Environments, says that "assessing the most vulnerable [people] needs to be based on micro-level economic productivity, [local] disease burden and a visual survey of living conditions".

He adds that housing improvements "must occur within a climate where all parties - government, business and society - are working together".

Williams says that focusing on housing to improve health should not solely be the remit of health agencies and that policymakers need to acknowledge the relationship between substandard living conditions and social consequences, such as poor health.

"We are failing to look at the co-dependencies and interrelationships between health and housing," he says. "Governments need to focus on social development that tackles the interdependency between these two things."